My high school muscle man with a history of spina bifida who was excited to start the fall weight training class is on strict no-lifting precautions for the first month of school following surgery for a shunt revision. A preschool teacher was concerned that she might damage another student with the magnets on her whiteboard. Another preschooler was unsteady on her feet with extra challenging behavior the first week of school, and is doing much better now that her shunt malfunction has been repaired.
Many children with mobility impairments due to spina bifida, intraventricular hemorrhage related to premature birth, cerebral palsy, and some genetic disorders may also have a medical history that includes hydrocephalus. Other children we see in our clinics and schools may also have hydrocephalus without other significant health issues or mobility problems.
According to UCLA Neurosurgery, hydrocephalus occurs in an average of 3-4 out of 1,000 babies born. Hydrocephalus is the result of an imbalance in the flow of cerebrospinal fluid (CSF) through the central nervous system. CSF provides protection, metabolic waste removal, and delivery of the body’s chemical messages via hormones throughout the brain and spinal cord. In a normally functioning system, CSF is produced by the brain, then gradually absorbed into the bloodstream, maintaining a constant level of pressure. In the case of hydrocephalus, excess fluid and excess pressure build up. This is usually as the result of overproduction of CSF or obstruction of the flow of CSF within the central nervous system. This places pressure on the brain and can cause damage to neural tissue.
Treatment of hydrocephalus consists of surgical placement of a ventriculoperitoneal (VP) shunt. This long, thin tube allows drainage of excess CSF from the ventricular cavities inside the brain to the abdominal cavity, where it can then be absorbed into the circulatory system.
The Hydrocephalus Association emphasizes that children with VP shunts should be treated like other children and be allowed to participate in physical activities including physical education along with their peers. The Spina Bifida Association also supports non-contact sports and regular activities including usual amounts of rolling and tumbling. That being said, it is recommend that the child and family consult with their neurosurgeon to establish guidelines on a case-by case basis. Any activity limitations should be communicated to therapists, teachers, and physical education teachers and be clearly delineated in a child’s Individualized Education Plan or Section 504 plan if applicable.
Some VP shunts are programmable to control the flow of CSF using a magnetic device. One precaution that several neurosurgeons recommend is keeping children with VP shunts away from strong magnetic fields to avoid accidental adjustment of the intended setting. Drawing with a Magna Doodle type toy or using alphabet refrigerator magnets is usually fine, but larger, stronger magnets found in some toys, electronics, and those frequently used for teaching science lessons on magnetism may pose a risk. Once again, any neurologist recommendations should be communicated to the family, health care team, and educational team and documented.
Those of us who work closely with a child and pay special attention to his or her cognitive or motor abilities may be able to help recognize early symptoms in the event of a shunt malfunction or infection.
Common symptoms include:
• Vision problems
• Irritability and/or tiredness
• Personality change
• Loss of coordination or balance
• Swelling along the shunt tract
• Difficulty in waking up or staying awake
• Decline in academic performance
• Redness along the shunt tract
By noting these symptoms early, children can be referred to their health care providers for intervention. This may help to avoid further complications and allow them to return to learning and playing and just being kids.
Image Courtesy of virtua.org